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This is VAERS ID 275225

Case Details

VAERS ID: 275225 (history)  
Age: 13.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-03-21
Onset:2007-03-21
   Days after vaccination:0
Submitted: 2007-03-28
   Days after onset:7
Entered: 2007-03-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / - LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2141AA / - RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Blood glucose, Dizziness, Electrocardiogram normal, Fall, Head injury, Headache, Muscle twitching, Pallor, Staring
SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: allergies - Erythromycin, Acanthosis nigricans, overweight
Diagnostic Lab Data: Accucheck 149, via normal EKG normal $g Done at medical center
CDC Split Type:

Write-up: Received immunizations at approximately 6:50PM, went to waiting room where brother and sister saw her fall to floor hitting her head (?left side) on a wooden playbox. They said she just stared for about 5 seconds then left arm / shoulder was twitching when RN arrived, patient was conscious and in a chair. She was pale, P68 at a FBV minutes, before 7pm, BP was 108/78, P78 standing. She was still dizzy and c/o headache, so ambulance was called. She was observed in ER and discharged home.


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